VENTRICULAR FIBRILLATION. 1. Safe scene, standard precautions. 2. Establish unresponsiveness, apnea, and pulselessness. 3. Quick look (monitor)

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1 LUCAS COUNTY EMS SUMMARY PAGES

2 VENTRICULAR FIBRILLATION 2. Establish unresponsiveness, apnea, and pulselessness 3. Quick look (monitor) 4. Identify rhythm 5. Provide 2 minutes CPR if unwitnessed by EMS 6. Defib 200J (biphasic) 360J (monophasic) 7. CPR 8. Hard wire (monitor lead II) 9. Intubate and confirm airway 10. IV Normal Saline 1000ml bag, large bore 11. Vasopressin 40 U IV push 12. Provide 2 minutes CPR 13. Defib 200J (biphasic) 360J (monophasic) 14. Amiodarone 300mg IV push 15. Provide 2 minutes CPR 16. Defib 200J (biphasic) 360J (monophasic) 17. Contact On-Line Medical Control, move patient 18. Epinephrine 1mg every 3-5 min. IV push 19. Amiodarone 150mg IVP Tab 800 Cardiac Protocol B-3 9/07

3 PULSELESS ELECTRICAL ACTIVITY (PEA) 2. Establish unresponsiveness, apnea, and pulselessness 3. Quick look (monitor) 4. Identify rhythm 5. Provide 2 minutes CPR 6. Hard wire (monitor lead II) 7. Intubate and confirm airway 8. IV Normal Saline 1000ml bag, large bore (consider fluid bolus) (consider underlying cause) 9. Vasopressin 40 units IV push 10. Provide 2 minutes CPR 11 Epinephrine 1mg 1:10,000 IV push (every 3-5 min) 12. Provide 2 minutes CPR 13. Atropine 1mg. IV push every 3-5 minutes up to 3mg/kg. (In absolute or relative Bradycardia) 14. Provide 2 minutes CPR 15. Contact On-Line Medical Control, move patient 16. Sodium Bicarb 1meq/kg. IV push Tab 800 Cardiac Protocol C-3 9/07

4 ASYSTOLE 2. Establish unresponsiveness, apnea, and pulselessness 3. Quick looks (monitor) 4. Identify rhythm 5. Provide 2 minutes CPR 6. Hard wire (monitor lead II) (TCP early if witnessed) 7. Intubate and confirm airway 8. IV Normal Saline 1000ml bag, large bore (consider fluid bolus) (consider underlying cause) 9. Vasopressin 40 units IV push 10. Provide 2 minutes CPR 11. Epinephrine 1mg 1:10,000 IV push 12. Provide 2 minutes CPR 13. Atropine 1mg. IV push 14. Provide 2 minutes CPR 15. Epinephrine 1mg 1:10,000 IV push1 16 Provide 2 minutes CPR 17. Atropine 1mg IV push 18. Provide 2 minutes CPR 19. Contact On-Line Medical Control 20. Consider discontinuation of efforts Tab 800 Cardiac Protocol D-3 9/07

5 BRADYCARDIA 1. Safe scene standard precautions 2. Reassure patient 3. ABC (airway, breathing, circulation) 4. Oxygen 5. Attach cardiac monitor (monitor lead II) 6. Identify rhythm 7. IV Normal Saline 1000ml bag 8 Vitals/pulse oximeter, 12 lead 9 If severely symptomatic, go to #10. Atropine 0.5mg. (mild bradycardia) 1mg if severe bradycardia (if TCP ineffective) IV push every 3-5 minutes up to a total dose of 3mg. 10. TCP (Transcutaneous Pacing). Explain procedure to patient, set rate at 80, start pacing at 20 milliamps, increase in increments of 5 milliamps until capture. If patient cannot tolerate pacer, and weighs over 50kg, administer Fentanyl 50 mcg IV push (1/2 dose in elderly). If allergic to Fentanyl, administer Valium 5mg. If weight is less than 50kg, administer Fentanyl 1mcg/kg. If a second analgesic dose is required, contact On-Line Medical Control for choice and dose of sedation medication. 11. Repeat vitals, if no change, start Dopamine drip at 5 ug/kg/min IV drip and titrate up to 20 ug/kg/min for effect. 12. Repeat vitals, if no change, Epinephrine 2ug/min IV drip, titrate up to 10ug/min for effect starting at 15gtt a minute. (2 ug/min) Second IV desired. 13. Contact On-Line Medical Control, move patient Tab 800 Cardiac Protocol G-3 9/07

6 Third Degree Heart Block, continued THIRD DEGREE AV BLOCK 2. Reassure patient 3. ABC (airway, breathing, circulation) 4. Oxygen 5. Attach cardiac monitor (monitor lead II) 6. Identify rhythm 7. IV Normal Saline 1000ml bag 8. Vitals, pulse oximeter, 12 lead 9. TCP (Transcutaneous Pacing). Explain procedure to patient, set rate at 80, start pacing at 20 milliamps, increase in increments of 5 milliamps until capture. If patient cannot tolerate pacer, and weighs over 50kg, administer Fentanyl 50 mcg IV (1/2 dose in elderly). If allergic to Fentanyl, administer Valium 5mg IV. If weight is less than 50kg, administer Fentanyl 1mcg/kg. If a second analgesic dose is required, contact On-Line Medical Control for choice and dose of sedation medication. 10. Repeat vitals, if no change Dopamine 5 ug/kg/min IV drip, titrate for effect up to 20 ug/kg/min. 11. Repeat vitals, if no change Epinephrine 2ug/min IV drip, titrate for effect (start at 15 gtts a minute) up to 10 ug/minute. 12. Contact On-Line Medical Control, move patient Tab 800 Cardiac Protocol H-4 9/07

7 Unstable Tachycardia, continued UNSTABLE TACHYCARDIA 2. Reassure patient 3. ABC (airway, breathing, circulation) 4. Oxygen 6. Attach cardiac monitor (monitor lead II) 6. Identify rhythm 7. IV Normal Saline 1000ml bag 8. Vitals, pulse oximeter 9. If patient weigh is greater than 50kg administer Fentanyl 50 mcg IV (1/2 dose in elderly). If allergic to Fentanyl, administer Valium 5mg. If weight is less than 50kg. administer Fentanyl 1mcg/kg. 10. Synchronized Cardioversion A. VT: 100J, 200J, 300J, 360J B. Wide Complex VT: 100J, 200J, 300J, 360J C. PSVT: 50J, 100J, 200J, 300J, 360J D. Atrial Fib/Flutter: 100J, 200J, 300J, 360J 11. Vitals, 12 lead 12. Contact On-Line Medical Control, move patient Tab 800 Cardiac Protocol I-4 9/07

8 PSVT, continued PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA (PSVT) 2. Reassure patient 3. ABC (airway, breathing, circulation) 4. Oxygen 5. Attach cardiac monitor (monitor lead II) 6. Identify rhythm 7 IV Normal Saline 1000ml bag 8. Vitals, pulse oximeter, 12-lead 9. Vagal maneuvers A. Baring down B. Coughing C. Breath holding (if possible) 10. Vitals/Adenocard 6mg rapid IV push, rapid saline flush 11. Vitals/Adenocard 12mg rapid IV push, rapid saline flush. May be repeated in 1 to 2 minutes. 12. Repeat set of vitals, if no change, and if QRS is narrow, administer Cardizem 20 mg (0.25mg/kg) slow IV push (over 2 min). If no change may be repeated after 15 minutes at 25mg (0.35 mg/kg). If patient develops Bradycardia or a Heart Block administer Calcium Chloride 1gm over 5 minutes. This is accomplished by putting 1gm in a 50ml bag of D5W using 10gtt tubing and run it at 100gtts a minute. If QRS is wide, go to V-tach Protocol K. 13. Contact On-Line Medical Control, move patient 14. If patient weigh is greater than 50kg administer Fentanyl 50 mcg IV (1/2 dose in elderly). If allergic to Fentanyl, administer Valium 5mg IV. If weight is less than 50kg. administer Fentanyl 1mcg/kg IV. 15. Vitals/Synchronized Cardioversion at 50J if no change, 100J if no change, 200J, if no change 300J, if no change 360J. Tab 800 Cardiac Protocol J-3 9/07

9 Ventricular Tachycardia, continued VENTRICULAR TACHYCARDIA 2. Reassure patient 3. ABC (airway, breathing, circulation) 4. Oxygen 5. Attach cardiac monitor (monitor lead II) 6. Identify rhythm 7. IV Normal Saline 1000ml bag 8. Vitals, pulse oximeter, 12-lead mg Amiodarone over 10 minutes. Repeat in minutes. 10. Vitals, 12-lead 11. Contact On-Line Medical Control, move patient 12. If patient weigh is greater than 50kg administer Fentanyl 50 mcg IV (1/2 dose in elderly). If allergic to Fentanyl, administer Valium 5mg IV. If weight is less than 50kg. administer Fentanyl 1mcg/kg IV. 13. Monomorphic synchronized Cardioversion 100J, 200J, 300J, 360J (polymorphic defibrillate 360J Monophasic, 200J Biphasic) 14. Vitals Tab 800 Cardiac Protocol K-3 9/07

10 Wide Complex Tachycardia of Uncertain Type, continued WIDE COMPLEX TACHYCARDIA OF UNCERTAIN TYPE 2. Reassure patient 3. ABC (airway, breathing, circulation) 4. Oxygen 5. Attach cardiac monitor (monitor lead II) 6. Identify rhythm 7. IV Normal Saline 1000ml bag 8. Vitals, pulse oximeter, 12-lead mg Amiodarone over 10 minutes. Repeat in minutes 10 Vitals, 12-lead 11. Contact On-Line Medical Control, move patient 12. If patient weigh is greater than 50kg administer Fentanyl 50 mcg IV (1/2 dose in elderly). If allergic to Fentanyl, administer Valium 5mg. If weight is less than 50kg. administer Fentanyl 1mcg/kg IV. 13. Synchronized Cardioversion 100J, 200J, 300J, 360J (if polymorphic defibrillate 360J Monophasic, 200J Biphasic). 14. Vitals Tab 800 Cardiac Protocol L-3 9/07

11 ATRIAL FIB/FLUTTER TACHYCARDIA (Borderline/Symptomatic) 2. Reassure patient 3. ABC (airway, breathing, circulation) 4. Oxygen 5. Attach cardiac monitor (monitor lead II) 6. Identify rhythm 7. IV Normal Saline 1000ml bag 8. Pulse oximeter 9. Vitals, 12 lead 10 Repeat set of vitals, if no change, and if QRS is narrow, administer Cardizem 20 mg (0.25mg/kg) slow IV push (over 2 min). If no change may be repeated after 15 minutes at 25mg (0.35 mg/kg). If patient develops Bradycardia or a Heart Block administer Calcium Chloride 1gm over 5 minutes. This is accomplished by putting 1gm in a 50ml bag of D5W using 10gtt tubing and run it at 100gtts a minute. If QRS is wide, go to V-tach Protocol K. 11. Contact On-Line Medical Control, move patient 12. If patient weigh is greater than 50kg administer Fentanyl 50 mcg IV (1/2 dose in elderly). If allergic to Fentanyl, administer Valium 5mg IV. If weight is less than 50kg. administer Fentanyl 1mcg/kg IV. 13. If Atrial Fib/Flutter synchronized cardioversion at 100J, 200J, 300J, 360J. Tab 800 Cardiac Protocol M-3 9/07

12 CARDIOGENIC SHOCK 2. Reassure patient 3. ABC (airway, breathing, circulation) 4. Oxygen (may have to assist ventilations) 5. IV Normal Saline 1000ml bag, large bore 6. Attach cardiac monitor (monitor lead II) 7. Identify rhythm, treat per protocol 8. Vitals, pulse oximeter, 12-lead 9 BP <110mm, Administer a fluid bolus ml IV Saline if the patient is hypovolemic. 10. Vitals/If the systolic BP is still <110 mmhg, administer a Dopamine drip starting at 5 ug/kg/min and titrate up to 15 ug/kg/min or until a target systolic BP 110 mm Hg is achieved. 11. Vitals/Contact On-Line Medical Control, move patient Tab 800 Cardiac Protocol N-2 1/06

13 Acute Coronary Syndromes 2. Position of comfort 3. ABC (airway, breathing, circulation) 4. Pulse oximeter 5. Oxygen 6. Vitals (12-lead, grade pain, risk factors) 7. Aspirin 162 mg. 8. Cardiac monitor (treat rhythm if indicated) Lead ECG 10. Classify patient 11. IV Normal Saline 1000ml 12. Treat according to signs and symptoms a. Choose a treatment sequence based upon symptoms and patient response (Page O-4) * b. Choose a treatment sequence for those patients with out classic anginal pain (Page O-4)* c. Choose a treatment sequence for STEMI patients (Page O-4) * 13 Vitals, 12-lead ** 14 Morphine 3mg, systolic BP >110, weight >50kg * 15 Contact On-Line Medical Control 16 Continue titration of treatment based upon patient response to treatment. *** 17 Vitals * See protocol determination (pages O1-O4) for administration of medications prior to obtaining a 12 lead ECG. ** It is assumed that vitals will be taken between all nitro and morphine dosages *** See protocol determinations (pages O1-O4) for administration of morphine prior to obtaining a 12-lead ECG. Tab 800 Cardiac Protocol O-6 9/07

14 ACUTE PULMONARY EDEMA 2. Reassure patient 3. ABC (airway, breathing, circulation) 4. Oxygen (CPAP/Intubation) 5. IV D5W 250ml bag (slow TKO rate) 6. Attach cardiac monitor (monitor lead II) 7. Identify rhythm/treat per protocol 8. Vitals, pulse oximeter, 12-lead 9. Lasix 1.0mg/kg IV push (Not to exceed 100mg) 10. Vitals, if patient weight is >50kg and BP >110mm Hg. administer Morphine 3mg IVP slowly. If BP <110 go to 13. (If the patient is taking any kind of erectile dysfunction medication contact On-Line Medical Control if nitroglycerin is to be administered). 11. Vitals, If patient weight is >50kg and BP >110mm Hg, administer one nitroglycerin. If BP <110mm Hg. go to Vitals, Dopamine 5-15ug/kg/min IV drip. If BP <110mm Hg titrate to effect. Target BP is110mm Hg. 13. Contact On-Line Medical Control, move patient Tab 800 Cardiac Protocol P-3 4/05

15 PREMATURE VENTRICULAR CONTRACTIONS 2. Reassure patient 3. ABC (airway, breathing, circulation) 4. Oxygen 5. IV Normal Saline 1000ml bag 6. Attach cardiac monitor (monitor lead II). 12-lead, group patient Treat per appropriate protocol. 7. Vitals, 12-lead 8. Vitals/contact On-Line Medical Control, move patient 9. Antiarrhythmic Tab 800 Cardiac Protocol Q-2 11/01

16 ALTERED MENTAL STATES (Psychiatric Disorders) 2. Establish responsiveness 3. Reassure patient 4. Vitals 5. Pulse oximeter 6. Attach cardiac monitor 7. If patient unstable: A. Oxygen B. IV Normal Saline 1000 ml Bag C. Test blood sugar D. Blood sugar <80 mg/dl, administer 50% Dextrose IV Push. If no IV, administer 1 unit Glucagon IM. >80 mg/dl, proceed to E. E. Vitals F. 4mg Naloxone IV Push G. Vitals H. Contact On-Line Medical Control I. 100mg Thiamine slow IV push (unless alcoholism is suspected, administer before D) J. 50% Dextrose IV push k mg Haldol IM Tab 900 Medical Emergencies Protocol A-4 7/03

17 COMA 2. Establish responsiveness 3. ABC (airway, breathing, circulation) 4. Vitals 5. Pulse Oximeter 6. Attach Cardiac monitor 7. Oxygen 8. IV Normal Saline 1000 ml bag 9. Test blood sugar 10. Blood sugar <80 mg/dl, administer 50% Dextrose IV push. If no IV, administer 1 unit Glucagon IM. Blood sugar >80 mg/dl, go to Vitals 12. Naloxone 4 mg IV push 13. Contact On-Line Medical Control mg Thiamine slow IV push (If alcoholism is suspected, administer before 9) % Dextrose IV push Tab 900 Medical Emergencies Protocol B-4 12/99

18 POISONINGS AND OVERDOSE EXTERNAL CONTAMINATION 2. Remove contamination agents 3. Decontaminate patient 4. Assess and treat using appropriate protocol 5. Contact On-Line Medical Control INTERNAL CONTAMINATION 2. Establish responsiveness 3. Reassure patient 4. ABC's (Airway, Breathing, Circulation) 5. Vitals 6. Pulse oximeter 7. Attach Cardiac monitor 8. Oxygen 9. IV Normal Saline 1000 ml bag 10. Test blood sugar 11. Blood sugar <80 mg/dl, administer 50% Dextrose IV push. If no IV, administer 1 unit Glucagon IM. Blood sugar >80 mg/dl, go to Vitals Tab 900 Medical Emergencies Protocol C-5 8/06

19 POISONINGS AND OVERDOSE 13. Naloxone 4 mg IV push 14. Contact On-Line Medical Control 15. Thiamine 100 mg slow IV push (If alcoholism is suspected, administer before 12) % Dextrose IV push Tab 900 Medical Emergencies Protocol C-6 8/06

20 SEIZURES 2. Establish responsiveness 3. ABC (airway, breathing, circulation) 4. Vitals 5. Oxygen 6. Attach cardiac monitor 7. IV 1000 ml Normal Saline 8. Test blood sugar 9. Blood sugar <80 mg/dl, administer 50% Dextrose IV push. If no IV, administer 1 unit Glucagon IM. Blood sugar >80 mg/dl, go to #9. 10 Take vitals 11. Administer 4 mg Naloxone IV push 12. Vitals 13. If BP >110 mm, administer 5 mg Valium slow IV push. May be repeated in 5 minutes (if no IV, may be given IM). 14. Vitals 15. Contact On-Line Medical Control mg Thiamine slow IV push (If alcoholism is suspected, Thiamine should be administered before #8) % Dextrose IV push Tab 900 Medical Emergencies Protocol D-4 12/99

21 SYNCOPE 2. Establish responsiveness 3. ABC (airway, breathing, circulation) 4. Vitals 12-lead 5. If unstable or age > Oxygen 7. Normal Saline IV 1000 ml (test blood) 8. Test blood sugar 9. Blood sugar <80 mg/dl, administer 50% Dextrose IV push. If no IV, administer Glucagon 1 unit IM. Blood sugar >80 mg/dl, go to # Vitals 11. Contact On-Line Medical Control 12. Thiamine 100 mg (If alcoholism is suspected, Thiamine should be administered before #9) % Dextrose IV push Tab 900 Medical Emergencies Protocol E-4 7/02

22 ASTHMA 2. Position of comfort 3. ABC (airway, breathing, circulation) 4. Oxygen (intubate if indicated) 5. Vitals, ECG (12 lead if applicable) 6. Pulse oximeter 7. Albuterol Aerosol 1 unit dose treatment, reassess 8. Second unit dose Albuterol 9. IV Normal Saline 1000ml 10. Prednisone 40mg orally (if unable to swallow Solu-Medrol 125mg IV) 11. Contact On-Line Medical Control 12. Epinephrine 0.3mg 1:1000 sub-q 13. Magnesium Sulfate 2gram drip Tab 900 Medical Emergencies Protocol F-3 1/06

23 ANAPHYLAXIS 2. Position of comfort 3. ABC (Airway, Breathing, Circulation) 4. Oxygen 5. Vitals (12-lead if applicable) 6. Pulse oximeter 7. Epinephrine 0.3mg subcutaneous (caution in >age 55, if unconscious due to shock, administer Epinephrine 0.3mg 1:10,000 IV) 8. IV Normal Saline 1000ml 9. Vitals 10. Shock, fluid bolus Normal Saline 250ml IV (consider shock pants) 11. If no change administer Solu-Medrol 125mg and Benadryl 25-50mg IV 12. Contact On-Line Medical Control Tab 900 Medical Emergencies Protocol G-4 1/06

24 CVA, continued 2. Establish unresponsiveness 3. ABC (Airway, Breathing, Circulation) 4. Vitals 5. Pulse oximeter 6. Attach Cardiac monitor 7. Oxygen 8. IV Normal Saline 1000ml 9. Test blood sugar 10. Blood sugar <80mg/dl, administer 50% Dextrose IV push. If no IV, administer 1 unit Glucagon IM. Blood sugar >80mg/dl, go to Vitals 12. Contact On-Line Medical Control Tab 900 Medical Emergencies Protocol H-4 12/99

25 HYPERTENSIVE CRISIS 2. Keep the patient quiet, preferably supine. 3. Oxygen. 4. Monitor cardiac rhythm (treat per appropriate protocol). 5. Pulse oximeter. 6. Vital signs (if diastolic BP >130mm Hg and patient is symptomatic, go to #8). 7. IV, normal saline TKO (10gtt tubing). 8. Contact On-Line Medical Control and anticipate the following orders. 9. Nitroglycerin, 0.4mg SL may repeat dosage every 5 minutes until diastolic pressure decreases 30% to maximum of diastolic 90mm Hg. 10. Vital signs. 11. Furosemide, 40mg IV. 12. Vital signs. 13. Morphine Sulfate, 2-4mg slow IV. May repeat every 5 minutes to a maximum dose of 0.2mg/kg. Tab 900 Medical Emergencies L-4 12/99

26 COPD, continued 2. Position of comfort 3. ABC (airway, breathing, circulation) 4. Oxygen 5. Vitals, ECG (12 lead if applicable) 6. Pulse oximeter 7. Albuterol 1 unit dose, reassess (if on Ipratropium Bromide (Atrovent), administer that) 8. Second unit dose Albuterol 9. Ipratropium Bromide (Atrovent) 1 unit dose 10. IV Normal Saline 250ml 11. Prednisone 40mg (if unable to swallow Solu-Medrol 125mg IV) 12. Contact On-Line Medical Control Tab 900 Medical Emergencies S-3 1/06

27 PEDIATRIC RESPIRATORY DISTRESS 2. Position of comfort 3. ABC (Airway, Breathing, Circulation) 4. Oxygen 5. Move patient to vehicle; notify On-Line Medical Control (brief assessment) 6. Assist ventilations (if indicated) 7. Vitals (Broselow tape), pulse oximeter 8. IV Normal Saline 250ml 9. Contact On-Line Medical Control Tab 1100 Pediatric Protocol A-3 8/06

28 PEDIATRIC ASTHMA 2. Position of comfort 3. ABC (Airway, Breathing, Circulation) 4. Oxygen assist ventilations if necessary 5. Vitals, pulse oximeter (Broselow Tape) 6. Albuterol aerosol ½ unit dose if <10kg. If >10kg, one unit dose 7. Move patient to vehicle, contact On-Line Medical Control (brief assessment) 8. Albuterol aerosol ½ unit dose if <10kg. If >10kg, one unit dose 9. IV Normal Saline 250ml 10. Prednisone 20mg (if unable to swallow Solu-Medrol 1mg/kg IV) 11. Vitals, pulse oximeter 12. Contact On-Line Medical Control (full assessment) 14. Vitals/ Epinephrine.01mg/kg (.01ml/kg) 1:1000 subcutaneous. Not to exceed 0.3mg. Tab 1100 Pediatric Protocol B-4 1/06

29 PEDIATRIC ALLERGY/ANAPHYLAXIS 2. Position of comfort 3. ABC (Airway, Breathing, Circulation) 4. Oxygen (Assist ventilations if necessary) 5. Vitals, pulse oximeter (Broselow Tape) 6. Epinephrine 0.01mg/kg 1:1000 (0.01ml/kg) subcutaneous not to exceed 0.3mg. 7. Albuterol ½ unit dose if <10kg. If >10kg, administer one unit dose 8. IV Normal Saline 250ml 9. Move patient to vehicle; contact On-Line Medical Control (brief assessment) 10. Vitals, pulse oximeter 11. Shock, Normal Saline fluid bolus 20ml/kg IV 12. If no change administer Solu-Medrol 1mg/kg and Benadryl 1mg/kg IV. 13. Contact On-Line Medical Control Tab 1100 Pediatric Protocol C-4 1/06

30 PEDIATRIC VENTRICULAR FIBRILLATION 2. Establish unresponsiveness, apnea, and pulselessness 3. CPR, move patient to vehicle, Contact On-Line Medical Control with assessment 4. Attach combo patch 5. Identify rhythm 6. Defib 2J/kg 7. Resume CPR 8. Defib 4J/kg 9. Assist ventilations 10. Hard wire, monitor lead II 11. IV/IO Normal Saline 250ml 12. Epinephrine 0.01 mg/kg (0.1ml/kg) 1:10,000 IV/IO 13. Defib 4J/Kg. (Within 30 seconds) 14. Amiodarone 5mg/kg 15. Defib 4J/Kg. (Within 30 seconds) 16. Contact On-Line Medical Control 17. Epinephrine 0.01 mg/kg (0.1ml/kg) 1:10,000 IV/IO 18. Defib 4J/Kg Tab 1100 Pediatric Protocol E-3 9/07

31 PEDIATRIC PULSELESS ELECTRICAL ACTIVITY (PEA) 2. Establish unresponsiveness, apnea, and pulselessness 3. CPR, move patient to vehicle, Contact On-Line Medical Control 4. Attach combo patch 5. Identify rhythm 6 IV/IO Normal Saline 250ml, (Broselow tape) 7. Intubate if indicated. 8. Epinephrine 0.01mg/kg (0.1ml/kg) 1:10,000 IV/IO 9. Hard wire patient, monitor lead II 10. Contact On-Line Medical Control full assessment 11. Epinephrine 0.01mg/kg (0.1ml/kg) 1:10,000 IV/IO Tab 1100 Pediatric Protocol F-3 9/07

32 PEDIATRIC ASYSTOLE 2. Establish unresponsiveness, apnea, and pulselessness 3. CPR, move patient to vehicle, Contact On-Line Medical Control 4. Apply combo patch 5. Identify rhythm 6. IV/IO Normal Saline 250ml (Broselow Tape). 7. Epinephrine 0.01mg/kg (0.1ml/kg) 1:10,000 IV/IO 8. Assist ventilations. Intubate if indicated 9. Hard wire patient, monitor lead II 10. Contact On-Line Medical Control 11. Epinephrine 0.01mg/kg (0.1ml/kg) 1:10,000 IV/IO Repeat every 3-5 minutes Tab 1100 Pediatric Protocol G-3 9/07

33 PEDIATRIC TRAUMA ARREST 2. C-spine control 3. Establish unresponsiveness, apnea, and pulselessness 4. CPR, move patient to vehicle, Contact On-Line Medical Control with brief assessment 5. Intubate if indicated, confirm 6. Apply combo patch 7. V-fib/V-tach: (with no pulse) (if other rhythm, go to #8) a. Defib 2J/kg b. CPR c. Defib 4J/kg 8. IV/IO Normal Saline 1000ml volume replacement with a bolus of 20ml/kg IO (Broselow Tape) 9. Hard wire patient, monitor lead II 10. Contact On-Line Medical Control with full assessment 11. Administer Normal Saline 20mg/kg bolus IV/IO Tab 1100 Pediatric Protocol H-3 8/06

34 PEDIATRIC HYPOTHERMIC CARDIAC ARREST 2. Move patient carefully 3. Remove patient's garments 4. Protect from heat loss 5. Establish unresponsiveness, apnea, and pulselessness 6. CPR, move patient to vehicle, Contact On-Line Medical Control with assessment 7. Attach combo patch 8. If V-fib/V-tach. defib 2J/kg, CPR, 4J/kg (Do not administer medications) 9. IV/IO Normal Saline 1000ml 10. Continue warming 11. Intubate, confirm 12. Hard wire patient, monitor lead II 13. Contact On-Line Medical Control Tab 1100 Pediatric Protocol I-2 8/06

35 PEDIATRIC BRADYCARDIA 2. ABC (airway, breathing, circulation) 3. Oxygen 4. Move patient to vehicle, Contact On-Line Medical Control with assessment 5. IV Normal Saline 250ml 6. Attach cardiac monitor (monitor lead II) 7. Identify rhythm 8. Vitals, (Broselow Tape), pulse oximeter 9. Epinephrine 0.01 mg/kg (0.1ml/kg) 1:10,000 IV/IO (repeat every 3-5 minutes) 10. Contact On-Line Medical Control 11. Administer Atropine 0.02mg/kg 12. TCP Tab 1100 Pediatric Protocol J-3 9/07

36 PEDIATRIC SYMPTOMATIC TACHYCARDIA. 2. ABC (airway, breathing, circulation). 3. Oxygen (intubation precautions). 4. Move patient to vehicle. Contact On-Line Medical Control with brief assessment. 5. Normal Saline 250ml IV. 6. Attach Cardiac monitor (monitor lead II). 7. Identify rhythm. 8. Vitals (Broselow Tape), pulse oximeter 9. QRS <0.08 with P waves, treat underlying cause. 10. QRS <0.08 with no P waves, administer Adenocard 0.1mg/kg not to exceed 6mg IV (may be doubled up to 12mg). No vascular access and patient unstable, go to QRS >0.08, administer Amiodarone 5mg/kg over 20 minutes. No vascular access and patient unstable, go to Synchronized cardioversion at 0.5J/kg - 1J/kg may be doubled to 2J/kg (if sedation required, contact On-Line Medical Control first. You may receive an order for Valium 0.2mg/kg.). 13. Contact On-Line Medical Control with full assessment. Tab 1100 Pediatric Protocol K-4 9/07

37 PREMATURE VENTRICULAR CONTRACTIONS 2. Reassure patient 3. ABC (airway, breathing, circulation) 4. Oxygen 5. IV Normal Saline 1000ml bag 6. Attach cardiac monitor (monitor lead II). 7. Vitals 8. Vitals/contact On-Line Medical Control, move patient 9. Antiarrhythmic Tab 1100 Cardiac Protocol L-2 7/02

38 PEDIATRIC SEIZURES 2. ABC (airway, breathing, circulation) 3. Oxygen 4. Move patient to vehicle, Contact On-Line Medical Control with brief assessment 5. Vitals (Broselow Tape), pulse oximeter 6. IV Normal Saline 250ml (blood sugar) 7. <80mg/dl, administer Dextrose 50% 1-2ml/kg IV and Normal Saline 1-2ml/kg, If no IV, administer Glucagon ½ unit IM. 8. Vitals 9. If BP adequate administer Valium 0.2mg/kg Valium slow IV. If no IV administer valium rectally 0.5mg/kg. 10. Vitals 11. Contact On-Line Medical Control with full assessment 12. Administer Dextrose 50% 1-2ml/kg IV and Normal Saline 1-2ml/kg Tab 1100 Pediatric Protocol P-5 6/06

39 POISONS AND OVERDOSES (UNCONSCIOUS UNKNOWN) External Contamination 1. See Hazardous Material Protocol Internal Contamination 2. Establish responsiveness 3. Reassure patient 4. ABC's (Airway, Breathing, Circulation) 5. Vitals (Broselow Tape) 6. Attach Pulse oximeter 7. Attach Cardiac monitor (treat per appropriate protocol) 8. Oxygen 9. Move patient to vehicle, Contact On-Line Medical Control with brief assessment 10. IV Normal Saline 250ml (test blood sugar) 11. Blood sugar <80mg/dl, administer Dextrose 50% 1-2ml/kg IV and Normal Saline 1-2ml/kg. Blood sugar >80mg/dl, go to 13. If no IV and blood sugar <80mg/dl, administer Glucagon ½ unit IM. 12. Vitals 13. Narcan 0.1mg/kg IV, (over 5 years, 2mg) 14. Contact On-Line Medical Control with full assessment 15. Dextrose 50% 1-2ml/kg IV and Normal Saline 1-2ml/kg. Tab 1100 Pediatric Protocol Q-5 8/06

40 CROUP, continued CROUP 2. Position of comfort 3. ABC (Airway, Breathing, Circulation) 4. Oxygen assist ventilations if necessary 5. Vitals, pulse oximeter (Broselow Tape) 6. Administer Epinephrine Aerosol (1:1000) 0.25 ml/kg then add 2ml normal saline 7. Move patient to vehicle, contact On-Line Medical Control (brief assessment) 8. IV Normal Saline 250ml 9. Vitals, pulse oximeter 10. Contact On-Line Medical Control (full assessment) Tab 1100 Pediatric Protocol T-4 6/06

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